Take Home Message:
Eight weeks of corrective exercises enhanced movement efficiency, dynamic and
static postural control, joint position sense, and self-reported function in a
non-fatigued state; however, the protocol did little to mitigate the effects of
fatigue on these measures.

Chronic
ankle instability (CAI) is associated with feelings of “giving way” or bouts of
instability, decreased self-reported quality of life, and lower levels of
physical activity. Thus, clinicians need treatments, like the National Academy of Sports Medicine (NASM) corrective exercise protocol, that target sensory
and motor components of ankle function. The authors examined the efficacy of the
corrective exercise protocol on self-reported function (Foot and Ankle Ability Measure (FAAM) and FAAM-Sport Subscale), movement
efficiency (double-limb squat (DLS), DLS with heel lift, single-limb squat), dynamic
postural control (Star Excursion Balance Test), static postural control (eyes
open and eyes closed balance), joint position sense, and fatigue sensitivity
compared with a non-treatment control condition among males with CAI. At
baseline, participants completed an assessment protocol following a short warm
up. Next, they underwent a progressive fatiguing protocol on a treadmill, and
were retested in a fatigued state. After the baseline assessment, an
investigator randomized a participant into the control or intervention group.
The intervention group received 8-weeks of supervised corrective exercises 3
times per week. The follow-up visit mirrored the baseline testing procedures.
The authors found that the intervention group improved more than the control
group in movement efficiency, sensorimotor function, and self-reported outcomes
during a non-fatigued state. In a fatigued state, the intervention group only
improved in the anterior-posterior center of pressure during static balance compared
with control group.

The
authors found that an individual with CAI can improve sensorimotor function with
a corrective exercise protocol, but improvements may not be sustained following
activity. These results are consistent with the current literature regarding
rehabilitation outcomes. A combination of exercises to target sensory and motor
impairments effectively improves a variety of outcomes better than a single intervention
strategy alone. In addition to overall improvements in function, the corrective
exercises improved self-reported function, which is a common goal of
rehabilitation. Unfortunately, the exercises failed to target fatigue sensitivity.
Even after 8-weeks of increasing the difficulty of the corrective exercises,
the participants failed to sustain the improvements when fatigued. This may be
problematic as fatigue sensitivity may play a role in increasing a person’s risk
for subsequent ankle injury in CAI. The authors suggest administering the
interventions in a fatigued state may mitigate the effects of fatigue; but,
this is understudied in those with CAI. Clinicians should be aware that using
the NASM corrective exercises may successfully address sensory and motor
deficits in those with ankle sprains, however, alternative strategies may be
necessary to address the effects of fatigue.

Questions for Discussion:
Would you consider using the NASM corrective exercises as your rehabilitation
approach for individuals with CAI? Should we expect to see changes in fatigue
sensitivity if we do not put patients through fatiguing exercises during
treatment?

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